A head injury could cost a footballer more than the World Cup

Liverpool goalkeeper, Loris Karius, made crucial errors during the recent Champions League final, including throwing the ball to Real Madrid striker, Karim Benzema. Five days after the match, Karius was diagnosed with concussion.

About 1% of people who suffer a blow to the head have life-threatening injuries (mainly bleeding in the brain) and need advanced medical treatment, sometimes including brain surgery. About 30% of people develop concussion – a catch-all term that describes impaired brain function due to head injury – with a range of symptoms, such as nausea, vomiting and dizziness, as well as impaired thinking that can last months. But most people who suffer a blow to the head have no lasting ill effects. The problem is that all three groups can initially appear the same.

When a patient is admitted to an emergency department (A&E) with a head injury, a structured assessment and brain scans are used to identify patients who may have life-threatening injuries. However, despite a ton of research in this area, we still can’t reliably predict who will develop concussion.

If a patient injures their head again, while concussed, it can lead to a catastrophic worsening of their symptoms. So the standard advice in the UK is that all patients with head injuries should avoid contact sports for two to four weeks following injury, and they should seek further medical attention if their symptoms persist.

Assessing a player, pitch side, in the middle of a competitive football match, is a very different challenge, though. Without the benefit of CT scans, the medic must first determine whether the player has a potentially life-threatening injury that needs hospital treatment. Then they must determine whether the player has a concussion and cannot play on.

The symptoms of concussion may not be immediately apparent, making it difficult to diagnose. This difficulty was demonstrated in the case of Jamie Roberts, the Welsh international rugby player, who played on for 15 minutes in 2008 with a fractured skull, after passing a pitch-side medical assessment.

Most footballers who suffer a blow to the head will have no underlying brain injury. A balance must be found that protects player welfare and allows players to safely play on when possible.

Lessons from rugby union

This is an area where football could learn from rugby. In August 2015, rugby union introduced a head injury assessment that outlines criteria for the immediate assessment and removal of players with a head injury, pitch side, and for the identification of delayed concussion symptoms.

Identifying head injury in rugby union is perhaps easier, as it’s a full contact sport and recently introduced pitch-side video assisted referees. The UK Football Association, to its credit, has released recent guidance recommending that head-injured players who have periods of loss of consciousness should be removed from play. FIFA might also want to consider strengthening its position on head injuries in football. Extending existing guidelines to include the assessment of delayed concussion symptoms would be helpful.

Hopefully, greater awareness in football will equip coaches and the medical support team to recognise when a player has been affected by a head injury and empower them to remove the athlete from play.